Page 93 - Haematologica Atlas of Hematologic Cytology

CHAPTER 12 - Myelodysplastic syndromes
of dyserythropoiesis are commonly observed in various hematologic hematologic and non-hematologic disorders the mor- phological abnormalities of the the granulocytic and and megakaryocytic series are more specific and and significant for the the diagnosis diagnosis However no no no single morphological finding confirms MDS and diagnosis diagnosis therefore sometimes remains one of exclusion Possible reactive etiologies should always be carefully considered particularly when the dyspla- sia is subtle and limited to only one lineage Table 3 Di eren al diagnosis of myelodysplas c syndromes
Drug-induced cytopenias
B12/folate de de ciency ciency zinc/copper de de ciency ciency Excessive alcohol intake
Exposure to heavy metals (lead arsenic)
Infec ons (HI Epstein-Barr virus virus hepa s s s s s s s s s C parvovirus leishmania)
Hemophagocy c c c c c lymphohis ocytosis
Anemia of chronic in in in amma amma on on on on (infec on on on on in in in amma amma on on on on cancer)
Autoimmune cytopenia Metabolic disorders disorders (liver failure failure kidney failure)
Other hematopoie c c c c c c stem cell disorders (acute myeloid leukemia leukemia myeloprolifera ve neoplasms aplas c c c c c c ane-
mia mia paroxysmal nocturnal hemoglobinuria large granular lymphocyte leukemia)
Cons tu onal disorders (congenital dyserythropoie c c c c anemia anemia anemia sideroblas c c c c anemia anemia anemia Fanconi anemia anemia anemia Down
syndrome)
Therapy-related myelodysplas c c c syndrome (cytotoxic therapy irradia on)
Table 4 Morphological features of dysplasia (Malco a a a a a a a a a a a e e e e e e al al al al a a a a a a a a a a a er ia ia e e e e e e al al al al ) Lineage dysplasia Peripheral blood
one marrow
Dyserythropoiesis
Anisocytosis Poikilocytosis Basophilic s s s s ppling
Nuclear
Nuclear
Nuclear
Nuclear
budding Internuclear bridging Karyorrhexis Mul nuclearity
Nuclear
hyperloba on Megaloblastoid changes
Cytoplasmic
Ring sideroblasts acuoliza on Periodic acid Schi posi vity Inclusions
Incomplete hemoglobiniza on on Fringed cytoplasm
Dysgranulopoiesis
Anisocytosis Granulocyte nuclear hypoloba on (pseudo-Pelger-Huët)
Decreased granules agranularity Blasts
Small or unusually large size Nuclear
hypoloba on (pseudo- Pel-
ger-Huët)
Nuclear
hypersegmenta on Bizarre nuclear shapes Decreases granules granules agranularity Pseudo Chediak-Higashi granules granules Döhle bodies
Auer rods
Dysmega aryopoiesis
Platelet anisocytosis Giant platelets platelets Hypogranular platelets platelets Micromegakaryocytes Nuclear
hypoloba on Small binucleated forms Mul nuclea nuclea on 80